ABSTRACT Cancer survivors in the acute and extended phases of care would benefit from improvements in the quality and coordination of primary and cancer care they receive. Cancer researchers have left the management of rural cancer survivors largely unstudied. While evidence-based practice guidelines exist, implementation in rural primary care practices has fallen short. Studies have yet to fully identify the barriers preventing successful implementation of guidelines in these settings. Opportunities exist to improve the understanding of both the reasons why cancer survivorship care is sub optimal in rural primary care as well as to test mechanisms for helping practices implement systems that assure all cancer survivors can be identified and are receiving guideline concordant care. This study sets out to evaluate current practices in managing rural cancer survivors and test a KanSurvive Project ECHO intervention to transform practices for delivery of evidence-based survivorship care. The primary aims are to 1) describe gaps in care, infrastructure needs and processes of care for acute and chronic cancer survivorship in rural primary care clinics focusing on rural breast, colorectal, lung, and prostate cancer survivors while finalizing the KanSurvive Project ECHO intervention; 2) evaluate the effectiveness of practice facilitation integrated with telementoring program for enhancing adoption of evidence- based practice guidelines for breast, colorectal, lung, and prostate survivors; and 3) describe key facilitators and barriers to implementation of KanSurvive Project ECHO and evidence of related EHR documentation change in these practices. This novel project will provide a model for use of implementation science and the development of a ?community of practices? working together to improve rural cancer survivorship care from diagnosis to the end-of-life.